1. education

571842
research-article2015
PAN0010.1177/2050449715571842The assumption dilemma: do healthcare professionals have the teaching skills to meet the demands of therapeutic neuroscience education?The assumption dilemma: do healthcare professionals have the teaching skills to meet the demands of therapeutic neuroscience education?
Professional perspectives
The assumption dilemma: do
healthcare professionals have the
teaching skills to meet the demands
of therapeutic neuroscience education?
Pain News
2015, Vol 13(1) 40–42
© The British Pain Society 2015
Michael Stewart Clinical Specialist Physiotherapist, East Kent
Hospitals University NHS Foundation Trust, Canterbury, Kent
Introduction
The contemporary
paradigm shift
from a biomedical
understanding of
pain to a more
comprehensive
biopsychosocial
model comes with many personal and
professional challenges for both sufferers
and clinicians.1 When we consider the
rising epidemiological nature of persistent
pain within the Western world,2 and the
poor clinical outcomes resulting from
conventional, passive interventions,3 the
need for such a fundamental paradigm
shift becomes clear.
Recent epidemiological data bring our
need to meet these challenges into
alarmingly sharp focus. Van Hecke et al.4
found that persistent pain affects over
14 million people in England alone. It also
accounts for 4.6 million general
practitioner (GP) appointments per year.
Butler and Moseley5 suggest that by
reframing pain as an epidemic, we may
begin to draw useful comparisons with
other epidemics.
Historically, epidemics from measles to
cholera have been contained through
education and communication.6
Therefore, for clinicians to adequately
meet the demands of the
biopsychosocial model, it is imperative
that they develop their knowledge and
skills as practice-based educators.
Dreeben7 (p. 4) argues that patient
education forms ‘a significant component
of modern health care’. However, most
clinicians have a limited educational
toolkit.8 As the pain epidemic continues
to grow, we must ensure that all
clinicians feel equipped to guide their
patients through the complexities of
therapeutic neuroscience education
(TNE).
As a sufferer, an inability to make
sense of the often worrying and
persisting uncertainties of pain forces
many to retreat from life’s pleasures. As a
clinician, it is therefore vital to ensure a
collaborative facilitation of meaning in
those who live with pain. Bolton9 argues
that educational skills are merely
assumed in both practice and research,
while Briggs et al.10 found that, in many
disciplines, pain education accounted for
less than 1% of undergraduate
programme hours within the United
Kingdom.
This persistent undervaluing of our
educational role and the need for an
increased awareness of facilitatory skills
within healthcare places a practical
dilemma at the heart of pain education.
In his call for a transformative medical
education system, Quintero11 states, ‘In
order to respond to the current needs of
society, which is education’s main
objective, the learning processes of
physicians and their instruction must
change’. While highlighting the need for
clinicians to gain a greater understanding
of educational facilitation within practice,
this article will also consider how a
greater awareness of collaborative
learning and learning styles would better
enable practice-based educators when
helping people make sense of pain.
Facilitation and collaborative
learning
To facilitate an understanding of pain’s
complexities and the importance of selfdetermined, sustained self-management,
we must first develop facilitatory skills.
Facilitation can be defined as ‘A technique
by which one person makes something
easier for others’.12 (p. 177). Helping and
enabling are central to meaningful
facilitation. Yet, Knowles et al.13 (p. 257)
suggest the desire for practice-based
educators to ensure efficient and effective
learning ‘often leads to concentration on
what they are doing rather than what the
learner is doing’.
This traditional, copy and paste,
dualistic approach to education stems
from a lack of understanding regarding
andragogy and a fear of losing control as
an educator within learning
environments.14 The novelist
E. M. Forster provides a striking grasp of
the dilemma facing contemporary pain
education by suggesting, ‘Spoon feeding
40 Pain News l March 2015 Vol 13 No 1
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Professional perspectives
The assumption dilemma
in the long run teaches us nothing but
the shape of the spoon’, while Gilmartin15
suggests healthcare professionals need
to develop three key qualities in order to
meet the facilitatory demands of
practice-based education:
argues professional practice is chaotic
and requires ongoing reflection. To
adequately explore the cluttered
complexities of biopsychosocialism, the
learning environment must seek to
promote reflective engagement.
1. An ability to actively listen
2. Best use of peer-learning
opportunities
3. An understanding of group dynamics
Learning styles and gaining
interest
Whether healthcare professionals
endeavour to facilitate a meaningful
understanding of pain through either
one-to-one clinical interactions or group
settings, Fredricks16 suggests that in
order to engage patients in the process
of TNE, we must embrace collaborative
learning. Cross et al.17 highlight the
distinct differences between cooperation
and collaboration within practice-based
education. While cooperation involves a
superficial level of joint engagement,
collaborative learning involves a
wholehearted desire and active interest in
collectively solving problems.
By moving from more conventional,
didactic teaching methods and by
embracing collaborative learning
activities, both practice-based educators’
and sufferers’ sense of connection is
amplified.18,19 However, many practice
settings remain implicitly unconducive to
collaborative engagement.20 When we
consider the diametrically opposed
seating arrangements seen within most
clinic settings, it is easy to see how
something so simple as where we sit in
relation to our patients can impact on our
ability to facilitate a meaningful
understanding of pain. Jaques21
suggests that collaborative learning must
involve side-by-side, close positioning,
not the more traditional, dualistic stance
of sitting opposite one another where the
implicit, physical metaphor is one of
division.
The move away from an expert model
of teaching is considered by TurnerBisset22 to be a reaction against the
technical rationale paradigm.23 Schon24
As practice-based educators aiming to
deliver patient-centred care, it is crucial
that we understand the undoubted
differences between how people learn.
Ewan and White25 argue that educators
must become acquainted with each
individual’s learning needs in order to
optimise learning. While learning styles
questionnaires (LSQ) provide some insight
and promote discussion,26 research
suggests that they don’t stand up to peer
review. Coffield et al.27 found that Honey
and Mumford’s26 questionnaire failed to
meet most of the minimum criteria for
validity, while Rayner28 argues LSQ risk
labelling learners and therefore must be
viewed in context.
Our ability to adapt our educational
delivery and tailor meaningful pain
education to individual needs is vital.
Silvia29 suggests this process must begin
with a better understanding of interest.
Interest is an emotion that serves two
main functions: motivation and
performance.29 Without an ability to
actively facilitate an interest in TNE,
patients will likely remain disengaged,
and practice-based educators will miss
opportunities for sustained cognitive and
behavioural change towards self-efficacy.
As practice-based educators, we must
understand what lies behind the emotion
of interest. Silvia29 states, ‘Finding
something understandable is the hinge
between interest and confusion’.
Through an appreciation of an individual
learner’s coping potential and an
understanding of the dynamic
relationship between challenge and
support,30 clinicians would feel better
equipped to respond to the everchanging demands of contemporary pain
education.
Conclusion
As the multifaceted and complex
demands of persistent pain continue to
mount on Western healthcare systems,
we must stop assuming that our
understanding of how to educate others
is merely reached through our
professional status. Instead, it is vital that
we wake up to our obligation to expand
our educational toolkits.
Daloz30 summarises our educational
duties by suggesting, ‘Like guides, we
walk at times ahead of our students, at
times beside them, and at times we
follow their lead. In sensing where to walk
lies our art’. While there is an undoubted
art to practice-based education,9 an
appreciation of the theoretical models
that underpin TNE and an active and
continued development of facilitatory
skills will enable healthcare professionals
to meet the demands of contemporary
pain education.
Although this article aims to explore
whether healthcare professionals
possess the teaching skills to meet the
demands of TNE, it can only offer a brief
insight into how an appreciation of
andragogy and adult learning theories
would better equip clinicians for the
challenges of contemporary pain
education. Further research is needed to
develop our understanding of how the
integration of established educational
knowledge and skills within practice
might impact on clinical outcomes and
the experiences of both sufferers and
healthcare professionals.
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